6 Is Not a Lucky Number

December 23: The Shift
Radiotherapy #6 was supposed to happen today, but the universe had other plans. The therapists detected a pleural effusion (fluid in my left lung), which has caused my internal anatomy to shift. Because the radiation plan is precise to the millimeter, we can't proceed until my lung is back where it belongs.

My radiation oncologist recommended draining the fluid with a chest tube, but there's a holiday hurdle: it’s nearly Christmas, and finding a lung specialist available for the procedure is proving difficult. For now, everything is on hold.

December 25: A Very "Vivid" Christmas
I spent my Christmas at the VGH Emergency Room. After blood work and an ECG, I ran into a familiar face—my running buddy, Nicole, was working the holiday shift. I managed to squeeze a promise out of her for a run around the hospital once she wraps up at 5:00 PM.

The ER experience was "vibrant," to say the least. While waiting for my X-ray, a woman in the waiting room began yelling, “I’m scared!” I joked with the nurse that if that’s how people react to X-rays, maybe I should skip it—and I’m the one coming from radiation!

The ER doctor eventually consulted with the respiratory specialist on duty. They decided to perform the drainage right there in the ER. The X-ray showed a significant pool of fluid; I’d like to imagine it’s as crisp and vivid as the waters of Lake Louise.

The Result: They drained about 800 ml of a "rose wine”. Samples were sent off to various tests.

Recovering at Home

I’m back home now. My ribs hurt on both the left and right sides, so at least I feel "balanced" in my discomfort. There will be a follow-up with the pleural clinic to see if I need a permanent catheter.

The one upside to a lung cancer diagnosis? The pain management options. If off-the-shelf Tylenol doesn’t cut it, there’s Fentanyl, Hydromorph, and OxyContin. I figure it’s never too late to pick up a new habit.

By the next morning, my back felt better, though my chest still aches—likely trauma from the needle passing through muscle (luckily, my upper body is mostly fat). Post-drainage X-rays show less fluid, but the lung remains collapsed because the tumor is blocking the airway.

December 29: Two Waiting Rooms and No Scones
Back at BC Cancer for radiotherapy. Unfortunately, it's another "no-go." The drainage shifted my lungs again, which means we need a new CT simulation and a total replan.

I spent the day moving from the "blue" waiting room to the "red" one. By the end of it, I’d officially lost my appetite for cheese scones. However, my oncologist is a miracle worker—he managed to squeeze me in for a new CTsim on the spot to identify the lung's new position.


January 2: The Technical Glitch
We tried to resume Radiotherapy #6 today with the new plan. After lying in position for 15 minutes, the therapist came in with bad news: a computer connectivity problem. We had to switch machines.

After another 15 minutes of staring at the ceiling—which is decorated with lovely cherry blossom trees—they delivered the final blow: the lungs have moved again. More fluid.

January 6: The Decision
Just met with my medical oncologist. She suggested:

1. Having malignant fluid is not yet a reason to suspect that the cancer progressed. This development did surprise her though. Progression will be assessed in -1 month based on a CT scan.
2. ⁠Complete the palliative radiation cycle, which may unblock the airway if I’m lucky.
3. ⁠Stay on Tagrisso until progression is confirmed, by a change in the tumors state. At that point, I’ll likely be switched to the Mariposa-2 protocol of Amivantamab + chemotherapy (carboplatin/pemetrexed).